Abstract

BACKGROUND:

Poor nutritional status and both hyper- and hypophosphatemia are associated with increased mortality in maintenance hemodialysis (HD) patients. We assessed associations of phosphate binder prescription with survival and indicators of nutritional status in maintenance HD patients.

Odds ratios of the associations of quintile of case-mix adjusted facility percentage of patients who received a prescription of phosphate binders with the odds of nutritional measures below the 25th percentile (n=23,952). US to International Conversions: serum albumin in g/dL to g/L, x10; serum creatinine in mg/dL to µmol/L, x88.4. Ref. = reference group. The results are based on data of 23,898 prevalent hemodialysis patients with ESRD duration at least 90 days from 923 facilities in DOPPS I–III (1996–2008). Case mix adjusted facility percentage of phosphate binder prescription was calculated from mixed linear regression adjusted for age, male gender, ESRD duration, 10 comorbid conditions, serum phosphorus, catheter use, serum calcium (albumin adjusted). Second stage logistic regression models used the same adjustments as in the first stage, phase, and region and accounted for facility clustering.